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Burnett County 7410 Co. Rd.K, No. 102, Siren,WI 54872 Office of Zoning Administrator v Q Z <br /> APPLICATION FOR LAND USE PERMITS <br /> r <br /> OWNER -na�TS C� fE�HONE C��JY/ � o <br /> MAILING ADDRESS f <br /> � <br /> .�f� r m <br /> PROPERTYADDRESS �(7/ i o <br /> LEGAL DESCRIPTION(see tax receipt) 7—3 "/7 <br /> C7 m <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTUR ❑ ADDITION ❑ 0 <br /> TYPE OF PERMIT(S): 1 c� <br /> FILLING/GRADING RING UNIT ❑ SUBDIVISION / Jj <br /> l/_ S <br /> STRIX:TURE/ADDITIONOSE: y}'1 {4 V <br /> !� � 3 o <br /> (Home/Cabin;Commercial Business; Bedroom; D ck;etc.) <br /> Ir�C n <br /> BUILDING CONTRACTOR: J � <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. -n 3 <br /> ZI m OCJ <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) p n <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. nci <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m v <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE,LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> S. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC., THE PLANS 0 o �, <br /> MUST BE SIGNED AND DATED BY THE OWNER. 2. <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN n o <br /> NEEDED. <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z <br /> CONDITIONS OF PERMIT: o <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT r ` <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. l/\ <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY <br /> PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER v <br /> SETBACK AREA. c� <br /> 5. C <br /> mW -0, '0 m <br /> 6. 3 cL (D F� '^ fl <br /> o CCN � o � 3 <br /> 7. Z 5; m o 1 <br /> o : T';2 A <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my rr .. ,, of A <br /> knowledge and belief it is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of W m nv. C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize Eo v <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- (D <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am w <br /> W . <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. T fD Cn <br /> CD 0 : <br /> CD m <br /> SIGN HERE d' <br /> (signature of owner or building tor) (date) <br /> CL <br /> ZONING ADMINISTRATOR \ <br /> <»<n <br /> N)fA N <br /> VNyI, NNNNOO <br /> VO CT N O O <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br />